Last Change:

10/16/2026

THE NATIONAL HEALTH INSURANCE ACT, 2018

Original names of the law: THE NATIONAL HEALTH INSURANCE ACT, 2018

Year: 2018

Type: Domestic law

Rights Category: Health

Link to external source: https://zambialii.org/akn/zm/act/2018/2/eng@2018-04-11
Description

An Act to provide for sound financing for the national health system; provide for a universal access to quality insured health care services; establish the National Health Insurance Management Authority and provide for its functions and powers; establish the National Health Insurance Scheme and provide for its systems, procedures and operation; establish the National Health Insurance Fund and provide for contributions to and payments from the Fund; provide for accreditation criteria and conditions in respect of insured health care services; provide for complaints and appeals processes; provide for the
progressive establishment of provincial and district health offices of the Authority; and provide for matters connected with, or incidental to, the foregoing.

Selected provisions
Section 3 - Application and power of exemption

3. (1) The provisions of this Act shall bind the Republic.
(2) The Minister may prescribe health care services that are
not covered by the Scheme.
(3) The Minister, by statutory instrument, may extend the
categories of individuals to whom this Act applies.

Section 5(f)(r) - Functions of Authority

5. The functions of the Authority are to—
(f) facilitate—
(i) access by poor and vulnerable people to insured
health care services; and
(ii) protection of the poor and vulnerable against
deprivation of health services;
(r) develop, in consultation with relevant stakeholders,
modalities of financing the coverage of indigent people
under the Scheme.

Section 13(1) - Membership and registration

13. (1) A citizen or established resident who is above eighteen
years shall be registered as a member of the Scheme in the
prescribed manner and form

Section 15 - Contributions and payment mechanisms

15. (1) An employer shall pay to the Scheme an employee’s
contribution consisting of the employer’s contribution and the
employee’s contribution at a prescribed percentage.
(2) The employer shall pay contributions to the Scheme at the
end of each month.
(3) A manager of a pension scheme shall pay to the Scheme a
retiree’s contribution, as prescribed.
(4) A self-employed citizen or established resident shall pay a
contribution to the scheme, as prescribed.
(5) The Minister shall, in consultation with the Authority,
prescribe rates of contribution for different benefit packages and
payment mechanisms available to the member.

Section 16 - Persons exempt from contributions

16. A citizen or established resident that may be exempted from payment of contributions under the Scheme include—

(a) a mentally or physically disabled person who is unable to work;
(b) an elderly person above the age of 65;
(c) a person classified as poor and vunerable by the Ministry
responsible for social welfare; and
(e) any other person as may be prescribed by the Minister.

Section 20 - Benefits of member’s contribution

20. (1) A member and a family member shall access the
benefits package under the Scheme as prescribed.
(2) Subject to this Act, insured health care services, in whole
or in part, shall be provided at national, provincial and district levels,
as prescribed.

Section 50 - Appeals

50. A person who is aggrieved by a decision of the Board
may appeal to the High Court